How is the diagnosis made?

Through multidisciplinary assessment (psychiatry, psychology, and where relevant endocrinology/paediatrics) considering duration, function, differential diagnoses and comorbidity. A diagnosis usually follows several visits and sometimes years of assessment.

How has patient numbers changed?

In the National Patient Register new F64 diagnoses among girls aged 13–17 rose from about 20/year in 2008 to a peak around 800/year in 2018, then levelled off and partly declined. Similar curves appear in Norway (NBTK referrals) and Finland (Tampere). Absolute numbers remain low in all ages.

What does the National Board of Health and Welfare say?

In December 2022 the guidance was updated: puberty blockers and cross-sex hormones for minors should as a rule be given only within clinical studies or in selected exceptions after individual assessment. Assessment and psychosocial support are emphasised.

SBU report 307 (2019) and the 2022 addendum found that the scientific evidence for hormonal treatment of children and adolescents is insufficient; long-term follow-up is lacking and studies have methodological problems. SBU did not take a position for or against treatment as such.

What do international guidelines say?

They differ. WPATH SoC 8 (2022) is more permissive and recommends individualised assessment without fixed age limits. NHS England, NICE and the Cass Review (2024) reach stricter conclusions aligning with SBU and the Swedish National Board. Finland (COHERE 2020) and Norway (Ukom 2023) have expressed similar caution.

What is the state of knowledge?

Uncertain. There are case series and observational studies but few randomised or long-term follow-ups. Both the Cass Review and SBU judge the evidence as low or very low for most outcomes (gender dysphoria, mental health, regret, fertility).

How does Sweden differ from other countries?

Sweden and the UK have tightened guidance since 2021–2024. Finland did so already in 2020. US and Canadian clinics largely follow WPATH. Denmark has concentrated care in a single unit. Differences concern evidence thresholds and centralisation more than the evidence itself.

What is the trend over time?

Three phases: (1) until ~2010 very few patients, mostly boys; (2) 2010–2018 rapid rise, especially among teenage girls; (3) from 2019 declining incidence and stricter guidance in several countries. It is too early to say if the decline reflects changed demand, changed referral routes or changed practice.

Why is the data called uncertain?

Populations are small, referral pathways have changed, diagnostic criteria have changed (DSM-IV → DSM-5, ICD-10 → ICD-11), and register data measure care contacts — not the underlying prevalence. Individual clinics or year-on-year variation cause large percentage swings on small numbers.

Demographics & Society

Healthcare 13–17

Adolescent gender dysphoria — Sweden's diagnoses, 2008–2023

New F64 diagnoses for girls aged 13–17 rose from ≈ 20/year (2008) to ≈ 800/year (2018) in the Swedish National Patient Register. These figures count registered diagnoses, which can be driven by several factors — greater awareness, reduced stigma, changed referral pathways and diagnostic criteria — and do not necessarily reflect an equally large rise in the underlying condition. After the Karolinska guideline change (2021) and SBU (2022) the trend has turned downward.

Nordics + UK — same curve, different timeline

Sweden: F64 diagnoses — Norway/Finland: referrals to national specialist clinic (NBTK/Tampere)

2008–2021 · index · Norden

Sweden: F64 diagnoses — Norway/Finland: referrals to national specialist clinic (NBTK/Tampere) · index · 2008–2021 · Norden
År	Norge	Danmark	Finland	Sverige
2 008	—	—	—	20
2 011	—	—	48	90
2 014	—	—	—	200
2 016	247	—	—	550
2 018	—	—	308	800
2 021	450	—	—	650

Source:

Sources & method

Data source

Definitions

— ‘Ny diagnos’ = incidens (första gången diagnos F64 registreras i patientregistret för individen).
— Norge/Finland-siffror avser remisser till nationell huvudklinik (NBTK/Tampere), inte alla diagnoser i patientregistret. Inte direkt jämförbara med Sveriges siffror i absolut tal — men trenden är densamma.

Uncertainties

— Sveriges siffror för 2022–2023 baseras på Socialstyrelsens uppdaterade statistik i patientregistret (kompletterande uttag efter 2020-rapporten); mindre efterregistrering kan förekomma för de senaste åren.
— Sverige saknar centralt remisstak, så incidens kan jämföras över tid men inte trivialt med länder som har centraliserade kliniker.

Sources for this page

The data comes from official primary sources.

Socialstyrelsen · Irregular
Socialstyrelsens nationella kunskapsstöd — vård av barn och ungdomar med könsdysfori
Nationellt kunskapsstöd om könsdysfori hos barn och unga
Latest data point 1 Dec 2022 · Source published 1 Dec 2022

Read the full investigation of how Sweden has changed.

Back to overview →

The question this page answers

How have diagnoses, assessments and care for gender dysphoria in children and adolescents developed over time according to official data and medical guidelines?

At a glance

Key figures — the most important numbers on this page

ICD-10 code (Sweden)

F64

Gender identity disorders. Sweden is migrating to ICD-11 (HA60 gender incongruence) from 2027.

Girls 13–17 with new F64 diagnosis

~20 → ~800

Annual incidence 2008 → 2018 (peak), National Patient Register. Declining after 2018.

Karolinska/ALB

May 2021

Ends routine puberty suppression / hormone treatment of minors outside research studies.

SBU 307/341

Feb 2022

Evidence for hormonal treatment of minors judged insufficient; long-term follow-up missing.

National Board of Health — new guidelines

Dec 2022

Puberty blockers and cross-sex hormones for minors only within research or selected exceptions.

Cass Review (NHS England)

Apr 2024

Systematic review: evidence for hormone treatment of minors is weak; routine care reconsidered.

Surgery (Sweden)

Age 18

Gender-affirming surgery is generally performed only from adulthood.

Method consequence

Small population

Absolute numbers are low → annual percentage swings look dramatic but are statistically noisy.

What does the data show?

Objective observations — not interpretations

The statistics show the number of individuals with an F64 diagnosis registered in care — not how many in the population experience gender dysphoria.
The 2008–2018 rise among girls aged 13–17 is documented in the National Patient Register; after 2018 incidence has levelled off and in some age groups declined.
Norway, Finland and the UK show similar S-shaped curves shifted by a few years — measured as referrals to national specialist clinics, not diagnoses.
SBU (2019/2022), the National Board of Health and Welfare (2022) and the Cass Review (2024) all conclude that the evidence for puberty blockers and cross-sex hormones in minors is insufficient — not that treatment is proven harmful, but that long-term studies are missing.
Guidelines differ between countries and organisations: WPATH SoC 8 (2022) is more permissive than NHS England/Cass, NICE and the Swedish updated recommendations.
A diagnosis count says nothing about cause. Several possible contributors (better access, less stigma, changed referral pathways, changed help-seeking, social spread) cannot be separated by register data alone.

Method note
Incidence = new diagnoses per year. Prevalence = individuals currently diagnosed at a point in time. The National Patient Register counts registered care contacts, not experienced gender dysphoria in the population. Changed referral pathways (from child psychiatry to specialised teams) and changed diagnostic criteria (DSM-IV → DSM-5, ICD-10 → ICD-11) shift the time series. At small populations (low hundreds per year) individual clinics or single-year variation cause large percentage swings — always compare absolute numbers, age and sex separately.

Definitions

How the numbers are counted — and what they do not cover

Sex (legal): The sex a person is registered with under the Swedish 1972:119 Act on determination of sex.
Gender identity: A person's internal experience of their gender. May or may not align with legal or bodily sex.
Gender expression: Outward expression such as clothing, name, address and body language linked to gender.
Gender dysphoria: Clinically significant distress from a mismatch between gender identity and assigned/bodily sex. Diagnosed under DSM-5 (Gender Dysphoria) and ICD-10 F64.0/F64.2.
Gender incongruence: ICD-11 term (HA60) replacing F64. Classified outside the chapter on mental disorders.
F64: ICD-10 codes for gender identity disorders. F64.0 transsexualism (adults), F64.2 gender identity disorder of childhood.
Referral: Written referral from e.g. child psychiatry or primary care to a specialised assessment unit. Recorded but does not equal diagnosis.
Assessment: Multidisciplinary medical and psychological evaluation preceding any diagnosis and treatment.
Puberty suppression: GnRH analogues delaying puberty. In Sweden after 2022, only within research or selected exceptions for minors.
Cross-sex hormones: Oestrogen or testosterone producing secondary characteristics of the experienced gender.
Gender-affirming surgery: Chest, genital or facial surgery. Generally requires adulthood in Sweden.
Social transition: Change of name, pronoun, clothing or hair without medical treatment. Not a medical intervention but can affect assessment.
Informed consent: Requirement that the patient (and, for minors, guardians) have received adequate information on benefits, risks and uncertainties.
Strength of evidence: Assessment of certainty, often via GRADE: high/moderate/low/very low. SBU and Cass rate hormone treatment of minors as low/very low.
Systematic review: Structured research synthesis that searches, appraises and combines all relevant studies under a pre-defined protocol.
Long-term follow-up: Follow-up beyond 5–10 years post-treatment. Largely missing for minors receiving hormonal treatment.
DSM-5: Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (APA, 2013). Uses ‘Gender Dysphoria’.
ICD-10 / ICD-11: WHO classification. Sweden currently uses ICD-10 (F64); transition to ICD-11 (HA60 gender incongruence) planned.
SBU: Swedish Agency for Health Technology Assessment. Systematic reviews of the evidence for treatments.
National Board guidelines: National recommendations for gender dysphoria care. Updated 2015 and December 2022.
Cass Review: Independent review of NHS England care for gender dysphoria in children and adolescents. Final report April 2024.
WPATH: World Professional Association for Transgender Health — an international professional body. Issues Standards of Care (SoC 8, 2022).
NICE: National Institute for Health and Care Excellence (UK). Published 2020 evidence reviews of puberty blockers and cross-sex hormones.

Primary sources

Agencies and research institutions behind this page

agencies/institutions

reports & studies

primary datasets

Frequently asked questions

Short answers to what is most often discussed

Clinically significant distress arising when a person's gender identity does not align with their assigned/bodily sex. Diagnostic criteria are in DSM-5 (Gender Dysphoria) and ICD-10 (F64). ICD-11 uses ‘gender incongruence’ (HA60) and places the condition outside the mental-disorders chapter.

Logical next steps if you want to understand the background

Adolescent gender dysphoria — Sweden's diagnoses, 2008–2023

Sources for this page

At a glance

What does the data show?

Definitions

Primary sources

Frequently asked questions

/en/healthcare

Long-term welfare costs

Adolescent gender dysphoria — Sweden's diagnoses, 2008–2023

What the diagnosis data shows

Nordics + UK — same curve, different timeline

Timeline: what happened

Sources for this page

At a glance

What does the data show?

Definitions

Primary sources

Frequently asked questions

Related topics

/en/healthcare

Long-term welfare costs